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This form must be submitted to HR Leave department prior to returning to work

This form must be submitted to HR Leave department prior to returning to work 2026

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The document is a Return to Work Release Form that employees must submit to the HR Leave department before returning to work after a medical leave. It requires completion by the treating physician, detailing the employee's work status, any restrictions, and necessary evaluations. The form aims to minimize the release of medical information while ensuring compliance with workplace accommodations and GINA regulations.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the EMPLOYEE INFORMATION section. Enter your last name, first name, middle initial, and employee ID. Specify your normal work week, shift times, division, department, title/position, and hours per day.
Next, ensure that the PHYSICIAN'S STATEMENT is completed by your treating doctor. They will need to indicate whether you can return with or without restrictions and provide relevant dates.
If there are any restrictions on your return to work, make sure these are clearly noted in the designated area. Your physician should also sign and date this section.
Review all information for accuracy before submitting the form. Once complete, save your document within our platform for easy access.

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